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Prevention of atrial fibrillation in patients with symptomatic chronic heart failure by candesartan in the Candesartan in Heart failure: assessment of Reduction in Mortality and morbidity (CHARM) program.
Am Heart J 2006; 151(5):985-91AH

Abstract

BACKGROUND

Atrial fibrillation (AF) is frequent in patients with chronic heart failure (CHF). Experimental and small patient studies have demonstrated that blocking the renin-angiotensin-aldosterone system may prevent AF. In the CHARM program, the effects of the angiotensin receptor blocker candesartan on cardiovascular mortality and morbidity were evaluated in a broad spectrum of patients with symptomatic CHF. CHARM provided the opportunity to prospectively determine the effect of candesartan on the incidence of new AF in this CHF population.

METHODS

7601 patients with symptomatic CHF and reduced or preserved left ventricular systolic function were randomized to candesartan (target dose 32 mg once daily, mean dose 24 mg) or placebo in the 3 component trials of CHARM. The major outcomes were cardiovascular death or CHF hospitalization and all-cause mortality. The incidence of new AF was a prespecified secondary outcome. Median follow-up was 37.7 months. A conditional logistic regression model for stratified data was used.

RESULTS

6446 patients (84.8%) did not have AF on their baseline electrocardiogram. Of these, 392 (6.08%) developed AF during follow-up, 177 (5.55%) in the candesartan group and 215 (6.74%) in the placebo group (odds ratio 0.812, 95% CI 0.662-0.998, P = .048). After adjustment for baseline covariates, the odds ratio was 0.802 (95% CI 0.650-0.990, P = .039). There was no heterogeneity of the effects of candesartan in preventing AF between the 3 component trials (P = .57).

CONCLUSIONS

Treatment with the angiotensin receptor blocker candesartan reduced the incidence of AF in a large, broadly-based, population of patients with symptomatic CHF.

Authors+Show Affiliations

Montreal Heart Institute, Montreal, Canada. a_ducharme@icm-mhi.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Duplicate Publication
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16644318

Citation

Ducharme, Anique, et al. "Prevention of Atrial Fibrillation in Patients With Symptomatic Chronic Heart Failure By Candesartan in the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) Program." American Heart Journal, vol. 151, no. 5, 2006, pp. 985-91.
Ducharme A, Swedberg K, Pfeffer MA, et al. Prevention of atrial fibrillation in patients with symptomatic chronic heart failure by candesartan in the Candesartan in Heart failure: assessment of Reduction in Mortality and morbidity (CHARM) program. Am Heart J. 2006;151(5):985-91.
Ducharme, A., Swedberg, K., Pfeffer, M. A., Cohen-Solal, A., Granger, C. B., Maggioni, A. P., ... Yusuf, S. (2006). Prevention of atrial fibrillation in patients with symptomatic chronic heart failure by candesartan in the Candesartan in Heart failure: assessment of Reduction in Mortality and morbidity (CHARM) program. American Heart Journal, 151(5), pp. 985-91.
Ducharme A, et al. Prevention of Atrial Fibrillation in Patients With Symptomatic Chronic Heart Failure By Candesartan in the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) Program. Am Heart J. 2006;151(5):985-91. PubMed PMID: 16644318.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevention of atrial fibrillation in patients with symptomatic chronic heart failure by candesartan in the Candesartan in Heart failure: assessment of Reduction in Mortality and morbidity (CHARM) program. AU - Ducharme,Anique, AU - Swedberg,Karl, AU - Pfeffer,Marc A, AU - Cohen-Solal,Alain, AU - Granger,Christopher B, AU - Maggioni,Aldo P, AU - Michelson,Eric L, AU - McMurray,John J V, AU - Olsson,Lars, AU - Rouleau,Jean L, AU - Young,James B, AU - Yusuf,Salim, PY - 2005/03/07/received PY - 2005/06/21/accepted PY - 2006/4/29/pubmed PY - 2006/5/27/medline PY - 2006/4/29/entrez SP - 985 EP - 91 JF - American heart journal JO - Am. Heart J. VL - 151 IS - 5 N2 - BACKGROUND: Atrial fibrillation (AF) is frequent in patients with chronic heart failure (CHF). Experimental and small patient studies have demonstrated that blocking the renin-angiotensin-aldosterone system may prevent AF. In the CHARM program, the effects of the angiotensin receptor blocker candesartan on cardiovascular mortality and morbidity were evaluated in a broad spectrum of patients with symptomatic CHF. CHARM provided the opportunity to prospectively determine the effect of candesartan on the incidence of new AF in this CHF population. METHODS: 7601 patients with symptomatic CHF and reduced or preserved left ventricular systolic function were randomized to candesartan (target dose 32 mg once daily, mean dose 24 mg) or placebo in the 3 component trials of CHARM. The major outcomes were cardiovascular death or CHF hospitalization and all-cause mortality. The incidence of new AF was a prespecified secondary outcome. Median follow-up was 37.7 months. A conditional logistic regression model for stratified data was used. RESULTS: 6446 patients (84.8%) did not have AF on their baseline electrocardiogram. Of these, 392 (6.08%) developed AF during follow-up, 177 (5.55%) in the candesartan group and 215 (6.74%) in the placebo group (odds ratio 0.812, 95% CI 0.662-0.998, P = .048). After adjustment for baseline covariates, the odds ratio was 0.802 (95% CI 0.650-0.990, P = .039). There was no heterogeneity of the effects of candesartan in preventing AF between the 3 component trials (P = .57). CONCLUSIONS: Treatment with the angiotensin receptor blocker candesartan reduced the incidence of AF in a large, broadly-based, population of patients with symptomatic CHF. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/16644318/Prevention_of_atrial_fibrillation_in_patients_with_symptomatic_chronic_heart_failure_by_candesartan_in_the_Candesartan_in_Heart_failure:_assessment_of_Reduction_in_Mortality_and_morbidity__CHARM__program_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(05)00653-8 DB - PRIME DP - Unbound Medicine ER -